Provider Demographics
NPI:1588448302
Name:QUILAL-LAN, LYZAMARIE VICTORIA (NP)
Entity type:Individual
Prefix:MRS
First Name:LYZAMARIE
Middle Name:VICTORIA
Last Name:QUILAL-LAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CREST DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1306
Mailing Address - Country:US
Mailing Address - Phone:201-724-9029
Mailing Address - Fax:
Practice Address - Street 1:160 NEW JERSEY ROUTE 17 NORTH
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-262-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14888300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner